Abstract：
BACKGROUND: Umbilical catheters are commonly inserted in newborns in the neonatal intensive care unit (NICU) yet are associated with serious adverse events (AEs) such as malposition, migration, infection, thrombosis, hepatic complications, cardiac effusion, and cardiac tamponade. There is a need to determine the incidence and risk factors for AEs to inform safe practice.
OBJECTIVE: The objective of this study was to determine the incidence and risk factors for AEs (all-cause and individual types) associated with umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) in the NICU.
METHODS: A retrospective cohort study was conducted in an Australian level-VI NICU over a 3-year period. Any newborn who had both a UVC and UAC insertion attempt was included.
RESULTS: There were 236 neonates who had 494 catheters (245 UVCs and 249 UACs). Of these, 71% of UVCs (95% confidence interval [CI]: 65.6-76.9%; incidence rate: 181.1-237.3 per 1000 catheter days) and 43.8% of UACs (95% CI: 38-50.5%; incidence rate: 102.0-146.3 per 1000 catheter days) were associated with an AE. The most common AE was malposition on first X-ray for UVCs (60.1%, 95% CI: 55.1-67.3) and UACs (32.6%, 95% CI: 26.8-39.6). A dwell time of ≥7 days was a significant predictor of UAC failure (incidence risk ratio: 1.5, 95% CI: 1.1-2.1, p = 0.006) and migration of the UVC (incidence risk ratio: 3.5, 95% CI: 1.0-11.5, p = 0.043).
CONCLUSIONS: Adverse events related to insertion occurred in a relatively high percentage of umbilical catheters placed. Increased dwell time remains a significant risk factor for catheter migration and overall failure. Practice change and consideration of risk factors for both individual and overall AE risk are necessary to reduce complications.
OBJECTIVE: The objective of this study was to determine the incidence and risk factors for AEs (all-cause and individual types) associated with umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) in the NICU.
METHODS: A retrospective cohort study was conducted in an Australian level-VI NICU over a 3-year period. Any newborn who had both a UVC and UAC insertion attempt was included.
RESULTS: There were 236 neonates who had 494 catheters (245 UVCs and 249 UACs). Of these, 71% of UVCs (95% confidence interval [CI]: 65.6-76.9%; incidence rate: 181.1-237.3 per 1000 catheter days) and 43.8% of UACs (95% CI: 38-50.5%; incidence rate: 102.0-146.3 per 1000 catheter days) were associated with an AE. The most common AE was malposition on first X-ray for UVCs (60.1%, 95% CI: 55.1-67.3) and UACs (32.6%, 95% CI: 26.8-39.6). A dwell time of ≥7 days was a significant predictor of UAC failure (incidence risk ratio: 1.5, 95% CI: 1.1-2.1, p = 0.006) and migration of the UVC (incidence risk ratio: 3.5, 95% CI: 1.0-11.5, p = 0.043).
CONCLUSIONS: Adverse events related to insertion occurred in a relatively high percentage of umbilical catheters placed. Increased dwell time remains a significant risk factor for catheter migration and overall failure. Practice change and consideration of risk factors for both individual and overall AE risk are necessary to reduce complications.
摘要：
背景：脐带导管通常插入新生儿重症监护病房（NICU）的新生儿中，但与严重不良事件（AE）有关，例如错位，迁移,感染,血栓形成,肝脏并发症,心脏积液,还有心脏填塞.有必要确定AE的发生率和危险因素，以告知安全实践。
目的：本研究的目的是确定NICU中与脐静脉导管（UVC）和脐动脉导管（UAC）相关的AE（全因和个体类型）的发生率和危险因素。
方法：在澳大利亚VI级NICU进行了一项为期3年的回顾性队列研究。包括任何同时有UVC和UAC插入尝试的新生儿。
结果：有236例新生儿有494个导管（245个UVC和249个UAC）。其中,71%的UVC(95%置信区间[CI]:65.6-76.9%;发生率:181.1-237.3/1000导管天)和43.8%的UAC(95%CI:38-50.5%;发生率:102.0-146.3/1000导管天)与AE相关。最常见的AE是UVC的首次X射线错位（60.1%，95%CI：55.1-67.3）和UAC（32.6%，95%CI：26.8-39.6）。≥7天的停留时间是UAC失败（发生率风险比：1.5，95％CI：1.1-2.1，p=0.006）和UVC迁移（发生率风险比：3.5，95％CI：1.0-11.5，p=0.043）的重要预测指标。
结论：与插入相关的不良事件发生在相对较高百分比的脐带导管中。增加的停留时间仍然是导管迁移和整体失效的重要风险因素。改变实践并考虑个体和总体AE风险的危险因素对于减少并发症是必要的。
目的：本研究的目的是确定NICU中与脐静脉导管（UVC）和脐动脉导管（UAC）相关的AE（全因和个体类型）的发生率和危险因素。
方法：在澳大利亚VI级NICU进行了一项为期3年的回顾性队列研究。包括任何同时有UVC和UAC插入尝试的新生儿。
结果：有236例新生儿有494个导管（245个UVC和249个UAC）。其中,71%的UVC(95%置信区间[CI]:65.6-76.9%;发生率:181.1-237.3/1000导管天)和43.8%的UAC(95%CI:38-50.5%;发生率:102.0-146.3/1000导管天)与AE相关。最常见的AE是UVC的首次X射线错位（60.1%，95%CI：55.1-67.3）和UAC（32.6%，95%CI：26.8-39.6）。≥7天的停留时间是UAC失败（发生率风险比：1.5，95％CI：1.1-2.1，p=0.006）和UVC迁移（发生率风险比：3.5，95％CI：1.0-11.5，p=0.043）的重要预测指标。
结论：与插入相关的不良事件发生在相对较高百分比的脐带导管中。增加的停留时间仍然是导管迁移和整体失效的重要风险因素。改变实践并考虑个体和总体AE风险的危险因素对于减少并发症是必要的。
